Written questions by Stafford.

What assessment he has made of the adequacy of the availability of Enhertu for the treatment of (a) HER2-positive and (b) HER2-low breast cancer.

The National Institute for Health and Care Excellence (NICE) is the independent body that makes recommendations for the National Health Service on whether new licensed medicines should be routinely funded by the NHS based on an evaluation of a treatment’s costs and benefits. These are very difficult decisions to make, and it is important that they are made independently and based on the available evidence. The NHS in England is legally required to fund medicines recommended by NICE.NICE has been able to recommend Enhertu for treating HER2-positive unresectable or metastatic breast cancer after one or more anti-HER2 treatments and for treating HER2-positive unresectable or metastatic breast cancer after 2 or more anti-HER2 therapies. Enhertu is now available for NHS patients in line with NICE’s recommendations.On 29 July 2024, NICE published final guidance on Enhertu for use in the treatment of HER2-low metastatic breast cancer, and it was unable to recommend this life-extending treatment. The only obstacle to access for NHS patients to Enhertu is price, and my Rt. Hon. Friend, the Secretary of State for Health and Social Care, met the manufacturers of Enhertu, AstraZeneca and Daiichi Sankyo to encourage them to re-enter discussions with NHS England with a view to reaching a price at which NICE would be able to recommend Enhertu.However, despite NICE and NHS England offering unprecedented flexibility, the companies were unable to offer Enhertu at a cost-effective price. NICE’s guidance will therefore remain unchanged for the moment. However, NICE remains open to being as flexible as possible with commercial partners and are willing to enter into a new NICE appraisal if there is movement on pricing.

What steps he is taking to (a) help ensure that NHS skin cancer referrals are completed within the 14-day target and (b) address the backlog in Farnham and Bordon constituency.

The Department is supporting the National Health Service in taking steps to reduce the time taken from referral to diagnosis of cancer, including skin cancer.As a first step, NHS England published guidance for local health and care systems and providers across England to achieve the Faster Diagnosis Standard (FDS) titled Implementing a timed skin cancer diagnostic pathway. The FDS pathway ensures patients receive a diagnosis of cancer, or rule out cancer, within 28 days of referral, as per the cancer waiting time standard.Since 2023/24, NHS England has been rolling out teledermatology services, which allow virtual reviews of dermoscopic images, to support achieving faster diagnosis. In providers where these have been fully implemented, improvements in workforce capacity have been seen, in some cases doubling the number of patients that can be reviewed per clinic, and improving FDS performance.Additionally, NHS England’s Getting It Right First Time (GIRFT) national report has provided recommendations to encourage the wider use of technology to ensure skin cancer patients get faster and more equitable access to care.In July, a report was published by NHS Frimley Integrated Care Board (ICB), which covers services in Farham and Bordon constituency, providing an update on elective care and cancer backlogs across the ICB. The report included steps taken to address the backlog, which included:- the trust holding weekly meetings to review long waiters, cancer patients, validation and prioritisation;- the use of more technology to improve appointments;- supporting patients while they wait; and- opening a new community diagnostic centre.The report is available at the following link:https://mycouncil.surreycc.gov.uk/documents/s103417/Frimley%20ICB%20Elective%20and%20Cancer%20Backlogs.pdfFinally, the forthcoming National Cancer Plan will have patients at its heart and will cover the entirety of a pathway including from referral to diagnosis.

What assessment his Department has made of the potential impact of proactive cardiac screening on preventing sudden cardiac deaths among young people.

In the United Kingdom, national screening programmes are introduced based on the recommendations of the UK National Screening Committee (UK NSC), an independent scientific advisory committee which advises ministers and the National Health Service in all four countries on all aspects of population and targeted screening and which supports implementation.The UK NSC last reviewed screening for sudden cardiac death in people under the age of 39 years old in 2019, and concluded that population screening should not be offered. Further information is available at the following link:https://view-health-screening-recommendations.service.gov.uk/sudden-cardiac-death/ The UK NSC is currently examining the evidence for this condition and will open a public consultation to seek comments from members of the public and stakeholders on this in due course. Further information, including on how to keep up to date on the work of the UK NSC, is available at the following link:https://www.gov.uk/government/organisations/uk-national-screening-committee

What funding has been allocated under the NHS 10-Year Plan to support cardiac screening programmes for young people.

In the United Kingdom, national screening programmes are introduced based on the recommendations of the UK National Screening Committee (UK NSC), an independent scientific advisory committee which advises ministers and the National Health Service in all four countries on all aspects of population and targeted screening and which supports implementation.The UK NSC last reviewed screening for sudden cardiac death in people under the age of 39 years old in 2019, and concluded that population screening should not be offered. Further information is available at the following link:https://view-health-screening-recommendations.service.gov.uk/sudden-cardiac-death/ The UK NSC is currently examining the evidence for this condition and will open a public consultation to seek comments from members of the public and stakeholders on this in due course. Further information, including on how to keep up to date on the work of the UK NSC, is available at the following link:https://www.gov.uk/government/organisations/uk-national-screening-committee

What steps his Department is taking to increase access to cardiac screening for young people with no prior symptoms of heart conditions.

In the United Kingdom, national screening programmes are introduced based on the recommendations of the UK National Screening Committee (UK NSC), an independent scientific advisory committee which advises ministers and the National Health Service in all four countries on all aspects of population and targeted screening and which supports implementation.The UK NSC last reviewed screening for sudden cardiac death in people under the age of 39 years old in 2019, and concluded that population screening should not be offered. Further information is available at the following link:https://view-health-screening-recommendations.service.gov.uk/sudden-cardiac-death/ The UK NSC is currently examining the evidence for this condition and will open a public consultation to seek comments from members of the public and stakeholders on this in due course. Further information, including on how to keep up to date on the work of the UK NSC, is available at the following link:https://www.gov.uk/government/organisations/uk-national-screening-committee

What steps he is taking to ensure that young people diagnosed with heart conditions receive appropriate (a) lifestyle advice, (b) treatment and (c) follow-up care to prevent cardiac arrest.

Most cases of sudden cardiac death (SCD) are related to undetected cardiovascular disease. In the younger population, SCD is often due to congenital heart defects. Given this, genomics has an important role to play in diagnosing and supporting the treatment and management of a number of cardiac conditions. The National Genomic Test Directory sets out the eligibility criteria for patients to access testing as well as the genomic targets to be tested and the method that should be used, and this includes genomic testing for a number of conditions which affect the heart, including, for example, testing for familial hypercholesteremia (FH), cardiomyopathies, Long QT syndrome, Brugada syndrome, and others. Further information on the National Genomic Test Directory is available at the following link:https://www.england.nhs.uk/publication/national-genomic-test-directories/ The 10-Year Health Plan includes a commitment to establish a genomics population health service, accessible to all by the end of the decade. Further information on the 10-Year Health Plan is available at the following link: https://assets.publishing.service.gov.uk/media/68760ad755c4bd0544dcae33/fit-for-the-future-10-year-health-plan-for-england.pdf The genomics population health service will be key to delivering a number of other commitments in the 10-Year Health Plan, including: expanding the National Health Service whole genome sequencing programme, with a focus on risks in relation to common disease areas including cardiovascular disease; expanding genomic testing for inherited causes of major diseases to allow earlier detection and intervention, including cardiovascular disease predisposition, for example due to FH; and beginning to integrate genomic insights into cardiovascular disease prevention and care through a service evaluation, with Our Future Health implementing Integrated Risk Scores. NHS England has published a national service specification for inherited cardiac conditions for all ages, that covers patients who often present as young adults with previously undiagnosed cardiac disease or families requiring follow up due to a death from this cause. The service specification is available at the following link: https://www.england.nhs.uk/wp-content/uploads/2017/11/cardiology-inherited-cardiac-conditions.pdf This describes the service model and mandated guidelines and guidance that should be followed to support the diagnosis and treatment of patients or family members. It also includes the requirement for inherited cardiac conditions services to investigate suspected cases. NHS England has also published a suite of national service specifications and standards for congenital heart disease (CHD), which define the standards of care expected from organisations funded by NHS England, to support and improve the diagnosis and treatment of patients with congenital cardiac problems. The standards for CHD are available at the following link: https://www.england.nhs.uk/wp-content/uploads/2018/08/Congenital-heart-disease-standards-and-specifications.pdf NHS England works closely with the Congenital Heart Networks to support work to maintain and monitor elective CHD surgery activity, waiting lists, and waiting times across England, noting that there are interdependencies with critical care capacity. NHS England’s Clinical Reference Group (CRG) has identified that there is scope for improvement in antenatal diagnosis rates for congenital heart defects, and has established a workstream to understand the causes of variation in foetal cardiology services across England. The CRG is also working closely with relevant professional organisations and charities to develop a national workforce strategy for CHD.

What steps his Department is taking to reduce the number of young sudden cardiac deaths through the 10 Year Health Plan.

Most cases of sudden cardiac death (SCD) are related to undetected cardiovascular disease. In the younger population, SCD is often due to congenital heart defects. Given this, genomics has an important role to play in diagnosing and supporting the treatment and management of a number of cardiac conditions. The National Genomic Test Directory sets out the eligibility criteria for patients to access testing as well as the genomic targets to be tested and the method that should be used, and this includes genomic testing for a number of conditions which affect the heart, including, for example, testing for familial hypercholesteremia (FH), cardiomyopathies, Long QT syndrome, Brugada syndrome, and others. Further information on the National Genomic Test Directory is available at the following link:https://www.england.nhs.uk/publication/national-genomic-test-directories/ The 10-Year Health Plan includes a commitment to establish a genomics population health service, accessible to all by the end of the decade. Further information on the 10-Year Health Plan is available at the following link: https://assets.publishing.service.gov.uk/media/68760ad755c4bd0544dcae33/fit-for-the-future-10-year-health-plan-for-england.pdf The genomics population health service will be key to delivering a number of other commitments in the 10-Year Health Plan, including: expanding the National Health Service whole genome sequencing programme, with a focus on risks in relation to common disease areas including cardiovascular disease; expanding genomic testing for inherited causes of major diseases to allow earlier detection and intervention, including cardiovascular disease predisposition, for example due to FH; and beginning to integrate genomic insights into cardiovascular disease prevention and care through a service evaluation, with Our Future Health implementing Integrated Risk Scores. NHS England has published a national service specification for inherited cardiac conditions for all ages, that covers patients who often present as young adults with previously undiagnosed cardiac disease or families requiring follow up due to a death from this cause. The service specification is available at the following link: https://www.england.nhs.uk/wp-content/uploads/2017/11/cardiology-inherited-cardiac-conditions.pdf This describes the service model and mandated guidelines and guidance that should be followed to support the diagnosis and treatment of patients or family members. It also includes the requirement for inherited cardiac conditions services to investigate suspected cases. NHS England has also published a suite of national service specifications and standards for congenital heart disease (CHD), which define the standards of care expected from organisations funded by NHS England, to support and improve the diagnosis and treatment of patients with congenital cardiac problems. The standards for CHD are available at the following link: https://www.england.nhs.uk/wp-content/uploads/2018/08/Congenital-heart-disease-standards-and-specifications.pdf NHS England works closely with the Congenital Heart Networks to support work to maintain and monitor elective CHD surgery activity, waiting lists, and waiting times across England, noting that there are interdependencies with critical care capacity. NHS England’s Clinical Reference Group (CRG) has identified that there is scope for improvement in antenatal diagnosis rates for congenital heart defects, and has established a workstream to understand the causes of variation in foetal cardiology services across England. The CRG is also working closely with relevant professional organisations and charities to develop a national workforce strategy for CHD.

Whether he plans to support wider access to cardiac screening provided by (a) Cardiac Risk in the Young and (b) other charities.

In the United Kingdom, national screening programmes are introduced based on the recommendations of the UK National Screening Committee (UK NSC), an independent scientific advisory committee which advises ministers and the National Health Service in all four countries on all aspects of population and targeted screening and which supports implementation.The UK NSC last reviewed screening for sudden cardiac death in people under the age of 39 years old in 2019, and concluded that population screening should not be offered. Further information is available at the following link:https://view-health-screening-recommendations.service.gov.uk/sudden-cardiac-death/ The UK NSC is currently examining the evidence for this condition and will open a public consultation to seek comments from members of the public and stakeholders on this in due course. Further information, including on how to keep up to date on the work of the UK NSC, is available at the following link:https://www.gov.uk/government/organisations/uk-national-screening-committee

What steps his Department is taking to improve NHS support for children and families with severe food allergies.

Section 100 of the Children and Families Act 2014 places a duty on schools to make arrangements for supporting pupils with medical conditions. Schools should ensure they are aware of any pupils with medical conditions, and have policies and processes in place to ensure these can be well managed. This includes allergies. The policy should also set out how staff will be supported in carrying out their role to support pupils, including how training needs are assessed and how training is commissioned and provided. Any member of school staff providing support to a pupil with medical needs should have received suitable training. The Food Standards Agency (FSA) encourages food businesses to complete the FSA’s allergen e-learning course and recommends that it is retaken annually to refresh knowledge and ensure that businesses are up to date on any changes which may have occurred. The FSA online training is free and offers practical advice to anyone wanting to learn more about food allergy. NHS England has also produced the Healthy School Child e-learning programme, which available at the following link: https://www.e-lfh.org.uk/programmes/healthy-school-child/ This programme is designed for healthcare professionals, including school nurses, working with children aged five to 12 years old. Module 5 of the e-learning programme includes sessions on asthma, eczema, and other allergies.

Whether his Department has made an assessment of the potential merits of making more emergency adrenaline auto-injectors available in community settings.

In November 2021, the Medicines and Healthcare products Regulatory Agency (MHRA) and the Commission on Human Medicine’s Adrenaline Auto-injector Expert Working Group, with wide-ranging input from patient groups, leading allergy experts, and healthcare professionals, published a report which outlined recommendations for the safe and effective use of adrenaline auto-injectors (AAIs), including quicker treatment, to help save lives. The MHRA has worked alongside the Department and the wider health system to take forward these recommendations, some of which are already in place. In June 2023, the MHRA, with the support of allergy awareness advocates, launched a safety campaign to raise awareness of anaphylaxis and to provide advice on the use of AAIs. The MHRA produced a toolkit of resources for health and social care professionals to support the safe and effective use of AAIs. Alongside this, the MHRA produced guidance, which states that prescribers should prescribe two AAIs to make sure patients always have the second dose, and that those who are prescribed AAIs should always carry two AAIs at all times. The majority of community pharmacies offer vaccinations. As part of offering this service, pharmacy contractors are expected to recognise and treat anaphylaxis. They must have immediate access to an anaphylaxis pack, including adrenaline. They are required to undertake training to administer adrenaline from an ampoule using a needle and AAIs in case of anaphylactic reactions.

What steps his Department is taking to support Integrated Care Boards to increase the availability of Fracture Liaison Services.

Fracture Liaison Services are commissioned by integrated care boards, which are well-placed to make decisions according to local need.Our 10-Year Health Plan committed to rolling out Fracture Liaison Services across every part of the country by 2030.

What assessment his Department has made of the trends in the levels of ambulance callouts to the same patient more than once in a 24 hour period.

No assessment has been made. The assessment and management of frequent callers is made at a local level by the relevant ambulance trust.

What recent steps his Department has taken to improve ambulance response times in (a) Surrey and (b) Hampshire.

The Government recognises that ambulance response times, including in Surrey and Hampshire, are not meeting the high standards patients should expect.We are determined to turn things around, and our Urgent and Emergency Care Plan for 2025/26, backed by almost £450 million of capital investment, commits to reducing ambulance response times for Category 2 incidents to 30 minutes on average this year.Our 10-Year Health Plan sets out how we will reform the National Health Service, including urgent and emergency care services, with a key focus on shifting urgent care into the community through new Neighbourhood Health Services.

What recent discussions he has had with Public Health England and the UK Health Security Agency on the use of mercury in dental amalgam fillings.

In England, we will continue to review the use of mercury in dental amalgam fillings and restrict and phase down their use. Administrations across the United Kingdom routinely work together to share best practice and to deliver on our common goals for improving patients’ experiences of healthcare services, including access to dentistry.Following the abolition of Public Health England and the establishment of the UK Health Security Agency, ministers regularly meet with key stakeholders to discuss a range of issues, including but not limited to dentistry.

Whether his Department plans to take steps to improve access to minimally-processed foods for (a) all consumers and (b) children and young people.

The Government’s Eatwell Guide already advises that people should eat more fruit and vegetables, and wholegrain or higher-fibre foods, as well as less processed meat, and food and drink that is high in sugar, calories, saturated fat, and salt.The Eatwell Guide principles are communicated through a variety of channels, including the NHS.UK website and Government social marketing campaigns. For example, the Better Health Healthier Families website and the Healthy Steps email programme, which aims to help families with primary aged children in England to eat well and move more.A range of actions that have already been taken to create a healthier environment to help children reduce their consumption of processed foods that are high in energy, saturated fat, salt, and free sugars, and to improve access to affordable minimally processed foods, include:- the Healthy Start scheme, which supported over 361,000 people in April 2025;- the Nursery Milk Scheme, which provides a reimbursement to childcare providers in England and Wales for a daily 1/3 pint portion of milk to children and babies; and- the School Fruit and Vegetable Scheme, which provides approximately 2.2 million children in Key Stage 1 with a portion of fresh fruit or vegetables per day at school.In relation to foods and drinks high in calories, saturated fat, salt, and free sugars, work on our commitments is progressing through:- implementing the television and online advertising restrictions for less healthy food and drink;- consulting on plans to ban the sale of high-caffeine energy drinks to children under 16 years old; and- giving local authorities stronger, clearer powers to block new fast-food outlets near schools and where young people congregate.

What assessment he has made of the potential merits of capping the cost of care homes.

Under the Care Act 2014, local authorities are tasked with the duty to shape their care market and to commission a range of high-quality, sustainable care support services to meet the diverse needs of all local people. This includes encouraging a wide range of service provision to ensure that people have a choice of appropriate services.Fee rates are set by providers of adult social care, the majority of which are in the independent sector. The Department does not have powers to set or recommend the level of fees that private care homes can charge. However, all businesses are required to comply with the Consumer Rights Act 2015 by ensuring that they use fair and clear terms in their standard agreements with customers.The Government is supporting local authorities by making available up to £3.7 billion of additional funding for social care authorities in 2025/26. This includes over £1 billion for the Market Sustainability and Improvement Fund (MSIF), with one of the three target areas local authorities can spend their allocations on being to improve fee rates to providers.In a letter I sent out to Council Leaders in January 2025, I set out the expectation that in 2025/26, when commissioning services, local authorities should ensure fee levels for care and support services take account of the actual costs of care in their area, including inflationary and all other pressures, such as the rise in National Living Wage and the changes to employers National Insurance Contributions.As part of our monitoring of the MSIF grant conditions and to understand fee rates more generally, local authorities are required to provide an annual return to the Department including data on the fee rates they pay care providers. The Government publishes this data annually, with the latest being available at the following link:https://www.gov.uk/government/publications/market-sustainability-and-improvement-fund-2024-to-2025-care-provider-fees/market-sustainability-and-improvement-fund-msif-provider-fee-reporting-2024-to-2025

What steps his Department is taking to increase the provision of dentistry services in Farnham and Bordon constituency.

The Government plans to tackle the challenges for patients trying to access National Health Service dental care with a rescue plan to provide 700,000 more urgent dental appointments and recruit new dentists to the areas that need them most. To rebuild dentistry in the long term, we will reform the dental contract with the sector, with a shift to focus on prevention and the retention of NHS dentists.The responsibility for commissioning primary care services, including NHS dentistry, to meet the needs of the local population has been delegated to the integrated care boards (ICBs) across England. For the Farnham and Bordon constituency, this is the NHS Frimley ICB. ICBs have been asked to start making extra urgent dental appointments available from April 2025. The NHS Frimley ICB is expected to deliver 6,626 additional urgent dental appointments as part of the scheme.ICBs have started to advertise posts through the Golden Hello scheme. This recruitment incentive will see up to 240 dentists receiving payments of £20,000 to work in those areas that need them most for three years.

What recent assessment he has made of the potential impact of changes to Food Standards Agency inspection charges on the financial viability of (a) small abattoirs and (b) private kill services.

Information on the 2025/26 charge rates for official controls (inspections) conducted in meat premises is available on the Food Standards Agency’s (FSA) website.https://www.food.gov.uk/business-guidance/charges-for-controls-in-meat-premisesAs in previous years, the impact of charges will be offset by a taxpayer-funded discount which provides the greatest proportional support to smaller businesses. The impact of the discount on different sized food businesses in England and Wales for 2025/26 is set out in the Cost Data Slides the FSA has published.The FSA is currently conducting an evaluation of the discount and will assess the impact of any changes it might propose in the light of this evaluation. No decisions have yet been taken.

What steps he is taking to raise awareness of restless leg syndrome with (a) GPs and (b) neurologists.

The National Institute for Health and Care Excellence publishes clinical knowledge summaries (CKS) as a source of information mainly for National Health Service staff working in primary care. The CKS on the diagnosis and clinical management of restless leg syndrome (RLS) was updated in February 2025, and is available at the following link:https://cks.nice.org.uk/topics/restless-legs-syndrome/General practitioners (GPs) have a generalist’s knowledge of RLS. GPs utilise the RLS Rating Scale to understand the impact on the patient and then to trial treatments. GPs are supported by neurology referral or specialist Advice and Guidance. This includes 27 specialised neurological treatment centres across the NHS in England, which provide access to neurological multidisciplinary teams to ensure that patients with RLS can receive specialised treatment and support, according to their needs.

Whether the upcoming 10-Year Plan for the NHS will include specific commitments to improve (a) diagnosis, (b) access to treatment and (c) support for research outcomes for people living with dementia.

The Government wants a society where every person with dementia receives high-quality, compassionate care from diagnosis through to the end of life. The 10-Year Health Plan will address the challenges diagnosed by Lord Darzi and will set the vision for what good joined-up care looks like for people with a combination of complex health and care needs, including people living with dementia. We are carefully considering policies, including those that impact people with dementia, with input from the public, patients, health staff, and our partners, as we develop the plan. In February, I hosted a roundtable discussion where partners shared how dementia, ageing well, and digital inclusion could be reflected in the 10-Year Health Plan.